Contemporary Management of Transient Ischemic Attack: Role of the Pharmacist

Rhoney, Denise H.

doi:10.1592/phco.31.2.193

Cited by 4 publications

(1 citation statement)

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“…Although robust evidence describes the benefits of utilizing pharmacists in the care of patients with diabetes, hypertension, and hyperlipidemia, very little work has been done exploring the benefits of pharmacists in secondary stroke prevention after a TIA or minor stroke. Suggested roles for pharmacists in the TIA population include identification of high‐risk patients, patient education about the importance of medication use, reducing obstacles in care that prevent efficient treatment, and determining the appropriate optimization of medications for the prevention of secondary events . In one study, pharmacists who participated in an outpatient stroke clinic focusing on secondary prevention identified an average of 2.8 drug‐related problems per patient.…”

Section: Discussionmentioning

confidence: 99%

The quality of medication optimization among patients with transient ischemic attack or minor stroke

Myers

Bravata

Sico

et al. 2019

J Am Coll Clin Pharm

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Objective To assess the quality of medication optimization for transient ischemic attack (TIA) and minor stroke patients across the Veterans Health Administration (VHA), and to identify characteristics predicting medication optimization for hypertension, hyperlipidemia, and diabetes. The scope of this study focuses on these three medication‐related conditions and defines optimization as medication changes or additions made within a guideline‐defined timeframe. Methods We constructed a retrospective cohort including all patients discharged with a TIA or minor stroke (index event) in any VHA Emergency Department (ED) or inpatient setting during fiscal year 2011. Inpatient and outpatient medical/pharmacy data were collected from a variety of electronic health sources for 1 year prior to and up to 90 days after discharge. Medication optimization for hypertension, hyperlipidemia, and diabetes was defined using relevant VHA and American Heart Association/American Stroke Association guidelines. For each of the three medication‐based outcomes, multivariable logistic regression models examined demographic, past medical history, and other clinical variables to identify predictors of optimization. Results Among 8427 patients, 33.7% (n = 2837) were eligible for medication optimization for hypertension, 55.2% (n = 4655) for hyperlipidemia, and 7.2% (n = 606) for diabetes. Guideline‐concordant medication optimization occurred for 28% of eligible patients with hypertension, 28% of patients with hyperlipidemia, and 34% of patients with diabetes. Factors that were associated with medication optimization included younger age, inpatient stay (vs discharge from the ED), greater baseline disease severity (higher blood pressure, low‐density lipoprotein [LDL] cholesterol, or hemoglobin A1c [glycated hemoglobin]), and primary care follow‐up within 30 days after the index event. Conclusion One‐third or fewer eligible patients with TIA or minor stroke had their medications optimized in a timely manner in concordance with evidence‐based guidelines. Interventions to improve timely medication optimization are needed to reduce the risk of recurrent vascular events in this high‐risk population.

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Section: Discussionmentioning

confidence: 99%